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Pesquisa : A02.513.514.162.600 [Categoria DeCS]
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PMID:29279562
Autor:Oshima Y; Iizawa N; Takai S
Endereço:Department of Orthopaedic Surgery, Nippon Medical School.
Título:Midterm Result of Arthroscopic Bicruciate Ligament Sutures for Multiligament Knee Injury in an Adolescent Patient.
Fonte:J Nippon Med Sch; 84(6):301-303, 2017.
ISSN:1347-3409
País de publicação:Japan
Idioma:eng
Resumo:BACKGROUND: Treatment of multiligament knee injuries, especially in adolescent patients, is challenging for orthopedic surgeons. Repair of collateral ligaments and reconstruction of cruciate ligaments are usually performed, however, ligament reconstruction with transphyseal or physeal-sparing techniques may lead to physeal damage and growth disturbances in skeletally immature patients. We present a case report on performing bicruciate ligament sutures arthroscopically in an adolescent patient. PATIENT AND METHODS: The patient was a 14-year-old boy, who was diagnosed with injuries to the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament. Single-stage arthroscopic primary suturing of the anterior and posterior cruciate ligaments and open medial collateral ligament suturing were performed 7 days after the injury. RESULTS AND DISCUSSION: The patient returned to routine activities, including high-level competitive sports, at 8 months post-surgery, and currently, 8.5 years after surgery, remains without complications. Suture repair was able to minimize the size of the bone tunnels and to re-establish knee stability with native tissues. Therefore, the application of sutures may be a useful option for repairing multiligament knee injuries, particularly in adolescent patients.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 858 MEDLINE  
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PMID:28455730
Autor:Bates NA; Nesbitt RJ; Shearn JT; Myer GD; Hewett TE
Endereço:Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA. batesna@gmail.com.
Título:Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro.
Fonte:Clin Orthop Relat Res; 475(10):2385-2396, 2017 Oct.
ISSN:1528-1132
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood. QUESTIONS/PURPOSES: We applied robotically controlled, in vivo-derived kinematic stimuli to the knee to assess ligament biomechanics in a cadaver model. We asked: (1) Does the application of abduction rotation increase ACL and medial collateral ligament (MCL) strain relative to the normal condition? (2) Does the application of internal tibial rotation impact ACL strain relative to the neutral condition? (3) Does combined abduction and internal tibial rotation increase ligament strain more than either individual contribution? METHODS: A six-degree-of-freedom robotic manipulator was used to position 17 cadaveric specimens free from knee pathology outside of low-grade osteoarthritis (age, 47 ± 8 years; 13 males, four females) into orientations that mimic initial contact recorded from in vivo male and female drop vertical jump and sidestep cutting activities. Four-degree rotational perturbations were applied in both directions from the neutral alignment position (creating an 8° range) for each frontal, transverse, and combined planes while ACL and MCL strains were continuously recorded with DVRT strain gauges implanted directly on each ligament. Analysis of variance models with least significant difference post hoc analysis were used to assess differences in ligament strain and joint loading between sex, ligament condition, or motion task and rotation type. RESULTS: For the female drop vertical jump simulation in the intact knee, isolated abduction and combined abduction/internal rotational stimuli produced the greatest change in strain from the neutral position as compared with all other stimuli within the ACL (1.5% ± 1.0%, p ≤ 0.035; 1.8% ± 1.3%, p ≤ 0.005) and MCL (1.8% ± 1.0%, p < 0.001; 1.6% ± 1.3%, p < 0.001) compared with all other applied stimuli. There were no differences in mean peak ACL strain between any rotational stimuli (largest mean difference = 2.0%; 95% confidence interval [CI], -0.9% to 5.0%; p = 0.070). These trends were consistent for all four simulated tasks. Peak ACL strain in the intact knee was larger than peak MCL strain for all applied rotational stimuli in the drop vertical jump simulations (smallest mean difference = 2.1%; 95% CI, -0.4% to 4.5%; p = 0.047). CONCLUSIONS: Kinematically constrained cadaveric knee models using peak strain as an outcome variable require greater than 4° rotational perturbations to elicit changes in intraarticular ligaments. CLINICAL RELEVANCE: Because combined rotations and isolated abduction produced greater change in strain relative to the neutral position for the ACL and MCL than any other rotational stimuli in this cadaver study, hypotheses for in vivo investigations aimed toward injury prevention that focuses on the reduction of frontal plane knee motion should be considered. Furthermore, reduced strain in the MCL versus the ACL may help explain why only 30% of ACL ruptures exhibit concomitant MCL injuries.
Tipo de publicação: JOURNAL ARTICLE


  3 / 858 MEDLINE  
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PMID:28355672
Autor:Geeslin AG; Geeslin MG; LaPrade RF
Endereço:Borgess Orthopedics, Kalamazoo, Michigan.
Título:Ligamentous Reconstruction of the Knee: What Orthopaedic Surgeons Want Radiologists to Know.
Fonte:Semin Musculoskelet Radiol; 21(2):75-88, 2017 Apr.
ISSN:1098-898X
País de publicação:United States
Idioma:eng
Resumo:Knee ligament injuries are common, and treatment methods are continually evolving. Accurate clinical diagnosis with imaging confirmation is critical to support appropriate treatment. Several imaging pearls allow for improved recognition of injuries. Stress radiographs may be obtained to quantify knee laxity. Magnetic resonance imaging allows assessment of the complex anatomy of the knee and has excellent sensitivity and specificity for many injuries.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  4 / 858 MEDLINE  
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PMID:28337656
Autor:Lee SY; Lim HC; Jang KM; Bae JH
Endereço:Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, Seoul, Republic of Korea.
Título:What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?
Fonte:Clin Orthop Relat Res; 475(8):1999-2010, 2017 Aug.
ISSN:1528-1132
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: When using the gap-balancing technique for TKA, excessive medial release and varus proximal tibial resection can be associated with internal rotation of the femoral component. Previous studies have evaluated the causes of femoral component rotational alignment with a separate factor analysis using unadjusted statistical methods, which might result in treatment effects being attributed to confounding variables. QUESTIONS/PURPOSES: (1) What pre- and intraoperative factors are associated with internal rotation of the femoral component in TKA using the gap balancing technique? (2) To what degree does femoral component rotation as defined by the navigation system differ from rotation as measured by postoperative CT? METHODS: Three hundred seventy-seven knees that underwent computer-assisted primary TKA attributable to degenerative osteoarthritis with varus or mild valgus alignment in which medial soft tissue release was performed, and those with preoperative radiographs including preoperative CT between October 2007 and June 2014 were included in the study. To achieve a balanced mediolateral gap, the structures released during each medial release step were as follows: Step 1, deep medial collateral ligament (MCL); Step 2, superficial MCL (proximal, above the pes anserine tendon) and semimembranosus tendon; and Step 3, the superficial MCL (distal, below the pes anserine tendon). Knees with internal rotation of the femoral component, which was directed by navigation, to achieve a rectangular mediolateral flexion gap were considered cases, and knees without internally rotated femoral components were considered controls. Univariable analysis of the variables (age, sex, BMI, operated side, preoperative hip-knee-ankle angle, preoperative medial proximal tibial angle, preoperative rotation degree of the clinical transepicondylar axis [TEA] relative to the posterior condylar axis [PCA], coronal angle of resected tibia, resection of the posterior cruciate ligament, type of prosthesis, and extent of medial release) of cases and controls was performed, followed by a multivariable logistic regression analysis on those factors where p equals 0.15 or less. For an evaluation of navigation error, 88 knees that underwent postoperative CT were analyzed. Postoperative CT scans were obtained for patients with unexplained pain or stiffness after the operations. Using the paired t-test and Pearson's correlation analysis, the postoperative TEA-PCA measured with postoperative CT was compared with theoretical TEA-PCA, which was calculated with preoperative TEA-PCA and actual femoral component rotation checked by the navigation system. RESULTS: After controlling for a relevant confounding variable such as postoperative hip-knee-ankle angle, we found that the extent of medial release (Step 1 as reference; Step 2: odds ratio [OR], 5.7, [95% CI, 2.2-15]; Step 3: OR, 22, [95% CI, 7.8-62], p < 0.001) was the only factor we identified that was associated with internal rotation of the femoral component. With the numbers available, we found no difference between the mean theoretical postoperative TEA-PCA and the postoperative TEA-PCA measured using postoperative CT (4.8° ± 2.7º versus 5.0° ± 2.3º; mean difference, 0.2° ± 1.5º; p = 0.160). CONCLUSIONS: Extent of medial release was the only factor we identified that was associated with internal rotation of the femoral component in gap-balancing TKA. To avoid internal rotation of the femoral component, we recommend a carefully subdivided medial-releasing technique, especially for the superficial MCL because once the superficial MCL has been completely released it cannot easily be restored. LEVEL OF EVIDENCE: Level III, therapeutic study.
Tipo de publicação: JOURNAL ARTICLE


  5 / 858 MEDLINE  
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PMID:28197694
Autor:van Egmond N; Hannink G; Janssen D; Vrancken AC; Verdonschot N; van Kampen A
Endereço:Department of Orthopaedics, Radboud University Medical Centre, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands. Nienkevanegmond@hotmail.com.
Título:Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time.
Fonte:Knee Surg Sports Traumatol Arthrosc; 25(3):800-807, 2017 Mar.
ISSN:1433-7347
País de publicação:Germany
Idioma:eng
Resumo:PURPOSE: The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. METHODS: Seven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°. RESULTS: There was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1-24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14-0.20), 0.27 MPa (95% CI 0.24-0.30), 132.9mm (95% CI 67.7-198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 -0.01), 0.08 MPa (95% CI 0.11 - 0.04), 47.0 mm (95% CI -105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm , respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm , respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference - 0.1° (95% CI -1.9 to 1.6)] of the valgus laxity was found. CONCLUSIONS: A release of the superficial MCL helps achieve the goal of reducing medial cartilage pressure in an OWO. There was considerable relaxation of the MCL after an OWO that resulted in a decrease of the mean CP in the medial and lateral compartments of the knee over time. However, cartilage pressure shifted from the medial to the lateral compartment only after release of the superficial MCL. The release of the superficial MCL caused a significant increase in the valgus laxity, which could influence stability after an OWO. LEVEL OF EVIDENCE: I.
Tipo de publicação: JOURNAL ARTICLE


  6 / 858 MEDLINE  
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PMID:28168644
Autor:Aunan E; Kibsgård T; Röhrl SM
Endereço:Department of Surgery, Innlandet Hospital Trust, Anders Sandvigs Gate 17, 2629, Lillehammer, Norway. eirik.aunan@sykehuset-innlandet.no.
Título:Minimal effect of patella eversion on ligament balancing in cruciate-retaining total knee arthroplasty.
Fonte:Arch Orthop Trauma Surg; 137(3):387-392, 2017 Mar.
ISSN:1434-3916
País de publicação:Germany
Idioma:eng
Resumo:PURPOSE: The effect of patellar eversion on ligament laxity measurements is still unclear. The purpose of this study was to investigate the influence of patellar eversion on medial and lateral ligament laxity measurements performed intra-operatively in total knee arthroplasty (TKA). METHODS: A total of 49 knees (27 female) with mean age 70 years (42-83) and mean body mass index of 28.5 were operated consecutively with a cruciate-retaining prosthesis. Medial and lateral ligament laxity in extension and in 90° of flexion was measured with the spatula-method intra-operatively after implantation of the prosthetic components with the patella everted and thereafter with the patella repositioned. The corresponding changes in gap height and inclination were calculated. RESULTS: A statistically significant increase of 0.6 mm (p < 0.001) in ligament laxity (condylar lift-off) laterally in flexion was found with the patella repositioned compared to everted. No differences were found in extension or medially in flexion. Correspondingly, the flexion gap increased by 0.4 mm (p < 0.001) and the flexion gap inclination increased by 0.6° (p = 0.002) when the patella was repositioned. CONCLUSIONS: Earlier research has shown that ligament laxity must be at least 1-2 mm to cause inferior function after TKA. In the current study, we found that the effect of patellar eversion on ligament laxity measurements is too small to be considered clinically relevant. PROSPECTIVE STUDY EVALUATING THE EFFECT OF PATIENT CHARACTERISTICS: Level II.
Tipo de publicação: JOURNAL ARTICLE


  7 / 858 MEDLINE  
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PMID:28165760
Autor:Mancini EJ; Kohen R; Esquivel AO; Cracchiolo AM; Lemos SE
Endereço:DMC Sports Medicine, Detroit Medical Center, Warren, Michigan, USA.
Título:Comparison of ACL Strain in the MCL-Deficient and MCL-Reconstructed Knee During Simulated Landing in a Cadaveric Model.
Fonte:Am J Sports Med; 45(5):1090-1094, 2017 Apr.
ISSN:1552-3365
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Noncontact anterior cruciate ligament (ACL) injury after valgus landing has been reported and studied biomechanically. However, the role of the medial collateral ligament (MCL) in dissipating these forces has not been fully elucidated. Purpose/Hypothesis: The purpose of this study was to investigate the role that the MCL plays in ACL strain during simulated landing. The hypothesis was that ACL strain would increase significantly in MCL-incompetent knees compared with the native knee and that reconstructing the MCL would return the values to those of the intact knee. STUDY DESIGN: Controlled laboratory study. METHODS: Eight fresh-frozen human cadaveric knees were used in this study. A materials testing machine applied a force of 2× body weight over 60 milliseconds to simulate landing after a jump. The knees were tested in 12 loading conditions, consisting of full extension or 15° of flexion combined with 7° of valgus or neutral alignment while the tibia was in external rotation, neutral rotation, or internal rotation. This test procedure was repeated on each specimen with the MCL transected and reconstructed. The superficial and deep MCL was transected along with the posterior oblique ligament, which was thought to simulate a worst case scenario. The MCL was reconstructed by use of semitendinosus and gracilis tendon grafts. RESULTS: During internal rotation at 0° of flexion and 0° of valgus, both the intact ( P = .005) and the reconstructed ( P = .004) MCL states placed significantly lower strain on the ACL than did the transected MCL. The reconstructed MCL state at 0° of flexion and 7° of valgus ( P = .049) along with 15° of flexion and 0° of valgus ( P = .020) also placed significantly lower strain on the ACL than did the transected MCL. For external rotation testing at 0° of flexion and 7° of valgus, the reconstructed MCL state placed significantly lower strain on the ACL than did the transected MCL ( P = .039). Finally, during neutral rotation, the ACL strain at 0° of valgus and 0° of flexion, and at 7° of valgus and 0° of flexion was significantly lower for the MCL-intact groups ( P < .028) and MCL-reconstructed groups ( P < .016) than the MCL-transected groups. CONCLUSION: The current findings demonstrate that during valgus landing, a knee with an incompetent MCL puts the ACL under increased strain. These values are highest in full extension with the tibia in internal and neutral rotation. This increased strain can be reduced to baseline levels with reconstruction. CLINICAL RELEVANCE: A knee with an incompetent MCL puts the ACL under increased strain. Once the MCL has healed in an elongated manner, MCL reconstruction should be considered.
Tipo de publicação: JOURNAL ARTICLE


  8 / 858 MEDLINE  
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PMID:28029798
Autor:Herbort M; Michel P; Raschke MJ; Vogel N; Schulze M; Zoll A; Fink C; Petersen W; Domnick C
Endereço:Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany.
Título:Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles.
Fonte:Am J Sports Med; 45(4):819-825, 2017 Mar.
ISSN:1552-3365
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). HYPOTHESES: First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. STUDY DESIGN: Controlled laboratory study. METHODS: The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. RESULTS: Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). CONCLUSION: In this human cadaveric study, semitendinosus and gracilis muscles successfully stabilize valgus moments applied to the MCL-insufficient knee when the knee is near extension. CLINICAL RELEVANCE: In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.
Tipo de publicação: JOURNAL ARTICLE


  9 / 858 MEDLINE  
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PMID:28017574
Autor:Kim MS; Koh IJ; Choi YJ; Kim YD; In Y
Endereço:Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Título:Correcting Severe Varus Deformity Using Trial Components During Total Knee Arthroplasty.
Fonte:J Arthroplasty; 32(5):1488-1495, 2017 May.
ISSN:1532-8406
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA. METHODS: Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS: There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment. CONCLUSION: Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:9002-88-4 (Polyethylene)


  10 / 858 MEDLINE  
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PMID:27871663
Autor:Dale KM; Bailey JR; Moorman CT
Endereço:Department of Orthopaedics, Duke University Medical Center, Box 3615, Durham, NC 27710, USA. Electronic address: Kevin.dale@duke.edu.
Título:Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.
Fonte:Clin Sports Med; 36(1):87-103, 2017 Jan.
ISSN:1556-228X
País de publicação:United States
Idioma:eng
Resumo:The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing.
Tipo de publicação: JOURNAL ARTICLE; REVIEW



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